The Accredited Drug Dispensing Outlets in Tanzania Community - - PowerPoint PPT Presentation

1 Management Sciences for Health

Stronger health systems. Greater health impact.

The Accredited Drug Dispensing Outlets in Tanzania

Eliphace Mkumbo and Dr. Suleiman Kimatta Community Providers of Medicines for Child Health

2 Management Sciences for Health

ADDO Initiative Background

• MSH and MOHSW-Tanzania carried out a pharmaceutical sector

assessment in 2001 with funding from the Gates Foundation

• Major access gaps identified—

 Quality of drugs and services  Registered pharmacies only in major urban areas  High stock-outs rates for essential medicines at primary health facilities  Essential prescription medicines illegally sold by duka la dawa baridi

• Solution = accredited drug dispensing outlet program (ADDO)

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ADDO Program Objectives

• Increase the availability of essential medicines to the rural

communities where majority of the people live

• Improve the quality of medicines that people buy from drug

sellers

• Improve the quality of dispensing services from both technical

and consumer perspectives

• Make essential medicines and pharmaceutical services

available and affordable* to people in the rural and peri-urban areas.

*Assuring that the accreditation process did not dramatically increase drug prices in shops.

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ADDO Strategy for Change

• National and local authorities, professional associations
• Participatory approach to project design and

implementation

Gain broad-based support from all stakeholders

• Create accreditation standards
• Decentralized inspection strategy; central oversight
• Products in stock registered by TFDA; local suppliers

Develop requirements and build stewardship and governance capacity

• Business skills of owners
• Case management and communication skills of dispensers
• Mentoring and supervision
• Record keeping

Build private sector capacity

• Ability to sell expanded range of medicines legally
• Loans
• Mobile technology applications (e.g., mobile money)

Provide incentives

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Types of Medicines ADDOs Sell

• Antibiotics (including

pediatric formulations of amoxicillin for pneumonia)

• ORS/zinc
• Antimalarials
• Antifungals
• Anti-inflammatory/

analgesics

• Oxytocic
• Anti-asthma
• Antihistamines
• Laxative
• Cardiovascular
• Diuretic
• Fluids/ electrolytes
• Local anesthetic
• Oral contraceptives
• Minerals/vitamins
• Anti-epileptics
• Antispasmodics

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ADDO Program Status

As of November 2015

Regions scaled up 25 (100%) Shops accredited (ADDOs) >8,000 Shops in accreditation process <2,000 Trained dispensers >19,000 Trained district inspectors >500

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• First choice for 45+% of medicine

purchases

• Over 9,000 drug shops compared

to nearly 800 registered pharmacies in Tanzania

• Close proximity—95% of

population within 5 km of a drug shop

• Perception of being more

personal; flexible payment methods

• Public health facilities often

farther away; essential medicines

• ften out-of-stock

Community Source of Medicines

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ADDOs as an Integrated Platform for Community- Based Public Health Interventions

Access to ACTs and insecticide- treated nets Child health/IMCI/ improve access to amoxicillin & zinc/ORS co-pack Source of family planning products Early TB case detection and referral Services to members of National Health Insurance Fund HIV/AIDS information dissemination

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Assuring Quality Products and Services (1)

• ADDOs must stock products registered by Tanzania Food and

Drugs Authority

• ADDOs buy products from approved local wholesalers
• Drug quality assurance testing on 243 samples ADDOs (203)

and pharmacies (40) in four regions showed—

• 227/243 samples met quality standards (93.4%)
• Pharmacy Council of Tanzania oversees ADDO operations—
• Official accreditation—inspection to assure that shops meet standards
• Qualifications of dispensers
• Premises meet quality standards
• Re-accreditation system (mechanism not yet functional)

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Assuring Quality Products and Services (2)

• ADDO training covers supply chain management components
• Dispensing environment (e.g., staff hygiene, clean storage space)
• Stock arrangement on shelves with proper labeling
• Stock rotation (FIFO and expiry monitoring)
• Storage conditions (e.g., security, temperature, moisture, light,

pests)

• Maintaining stock cards and sales ledgers to track inventory
• ADDO inspections performed quarterly by local inspectors;

3,262 district and ward inspectors have been trained

• Promising work with ADDO associations providing peer-peer

supervision

• New mobile technology to report on service indicators,

including product availability

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UNICEF Pilot Project in Three Regions

• UNICEF requested MSH to help improve community access to

amoxicillin DTs and ORS/zinc co-packs for childhood pneumonia and diarrhea through ADDOs in three pilot regions

• Amoxicillin DT and ORS/zinc co-packs had previously not been

available in the private sector

• Activities include—
• Orientation of district health office, ADDO, and supplier

personnel on how to supply/dispense new formulations

• Supervision of ADDO dispensers and owners in related practices
• Monitoring and reporting on availability of new products using

mobile technology

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CHW-ADDO-Health Facility Linkage

• Tanzania’s community health workers

(CHWs) are not allowed to dispense any medicines at all; they can only refer to a health facility

• ADDOs refer severely sick patients

to health facilities and refer patients who require medicines not available at ADDOs

• A formal link between ADDOs and

CHWs does not exist

• MSH project in Kibaha linked

ADDOs with CHWs and health facilities to improve community- based access to medicines

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Health Facilities Community Health Workers ADDOs

Malaria Family Planning Pneumonia Referrals

Strengthen Linkage at Community Level

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Expected Outcomes of Linkage

• Show CHW/ADDO/health facility willingness to collaborate
• Increase efficiencies and access; for example, CHWs refer

pneumonia cases to ADDO for treatment rather than distant health facility

• Enhance CHW, ADDO, and health facility workers’ knowledge

in reproductive, maternal, newborn, and child health

• Improve stock of essential RMNCH commodities and medicines

in ADDOs and health facilities

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95 81 95 100 90 90 90 95 80 88 96 96 92 64 84 80 88

10 20 30 40 50 60 70 80 90 100 ORS Zinc Amoxycillin ACT SP Folic Acid Quinine Female Condom Male Condom The Pills

Percent

Proportion of ADDOs with essential commodities: June and July 2015 (n = 24)

1st supervision 2nd supervision

RMNCH commodity availability: ADDOs

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Conclusions

• ADDOs are an important provider of appropriate treatment

for common childhood illnesses at community level

• Assuring the availability and quality of medicines is crucial and

is covered in ADDO training/supervision; availability of RMNCH commodities in ADDOs is good; 2013 data showed excellent product quality from ADDO samples

• Further exploration of how CHW-ADDO-health facility

linkages can strengthen referrals and increase timely appropriate treatment

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Stronger health systems. Greater health impact.

Saving lives and improving the health

• f the world’s poorest and most vulnerable people

by closing the gap between knowledge and action in public health.